New HIV drug combo rolled out in South Africa

South Africa has started distribution of the new anti-retroviral pill that combines three drugs to combat the HIV menace. The distribution began Sunday 1st of December 2019, to mark the World AIDS Day.

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This combination of three drugs in a single pill is expected to be available for 7.7 million South Africans living with HIV. South Africa has 20 percent of all the HIV positive population of the world say reports from UNITAID. The reports add that 15 percent of the global new cases of HIV and 10 percent of the deaths associated with HIV occur in South Africa. Despite such high numbers, only 62 percent of the HIV positive individuals and only 50 percent of the youth with HIV of South Africa receive anti-retroviral drug therapy. There are 37.9 million people worldwide living with HIV of which only 24.5 million receive antiretroviral drugs said the researchers.

The Global HIV Prevention Coalition targeted a 60 percent drop in HIV infections in 2018 and this had not been met. There has been a global decline in HIV infections by 17 percent but in 28 nations the numbers continue to rise with three out of four belonging to these 28 nations. Countries like Nigeria (by 8 percent) and Pakistan (by 56 percent) have shown alarming rise in numbers of HIV positive cases over the last few years. Countries such as South Africa, Democratic Republic of the Congo, Uganda and Zimbabwe have shown a decline of 39 percent, 37 percent, 36 percent and 28 percent respectively in HIV infections.

South Africa’s health minister, Zweli Mkhize, in a statement said that distribution of these medications and its consumption by the HIV positive would be the “fastest way to reduce HIV viral load” and said that this combination pill also has fewer adverse effects and is thus more acceptable to the patients. One of the ingredients of the combination is dolutegravir, which is being used across the developed nations say reports.

UNITAID was the main financer behind the development of this fixed dose combination. Robert Matiru of the global health development organisation UNITAID said in a statement, “The introduction of this new regimen, known as TLD, is a major milestone and game-changer for South Africa, which has the highest burden of HIV of any country in the world. The government has the very ambitious plan of switching the 4.8 million South Africans who are currently on the older regimen of HIV treatment on to this new regimen by 2021, in addition to getting the remaining [roughly] 3 million people who are not currently on HIV treatment on to this regimen by then as well. It’s a massive undertaking to put in place, and is a really welcome move for the people of South Africa.”
Matiru added that the currently used antiretroviral drugs would be replaced by this new combination pill and it would save costs to a great extent. This saving he said could help 5 million more individuals from getting access to antiretroviral drugs with the same budget he said.

Dr Michelle Moorhouse, of Ezintsha, Wits Reproductive Health and HIV Institute in Johannesburg said that this move would not only affect South Africa but also have an impact on global HIV scenario. Moorhouse said in her statement, “We are likely to see a dramatic impact on the rate of new infections. In fact, moving to DTG could halve the number of new infections in South Africa between now and 2038, especially if we get people on treatment more quickly. And as HIV in South Africa accounts for about 20% of infections globally, this impacts the global infection rate.” Matiru added, “Once South Africa scales up its response to include the 3 million who aren’t currently on treatment, that will help close the global gap.”

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Tabitha Ha, advocacy manager at StopAids, in a statement said, “Despite progress over the past few decades, HIV infection rates are still increasing at alarming rates in places such as Pakistan and South Sudan, and in regions such as eastern Europe. This means we are off track in meeting our global goal target to end Aids by 2030. While some countries are stepping up the fight, others are lagging way behind. Global prevention efforts need to be ramped up urgently in order to get us back on track and offer us the opportunity to turn the tide. We must collectively increase our financial investment in prevention tools, break down stigma and discrimination, as well as remove the legal and structural barriers that prevent people most likely to be affected with HIV from accessing healthcare.”

UNAIDS Executive Director Winnie Byanyima, on the occasion of World AIDS day in her speech said, “After starting late, today you are making remarkable progress against AIDS! More than five million South Africans living with HIV are now on antiretroviral therapy—20% of all the people on treatment in the world. There was a 53% reduction in the number of AIDS-related deaths from 2010 to 2018. More than 95% of pregnant women living with HIV are on treatment. HIV incidence declined by 44% between 2012 and 2017. Great progress!” She added, “But even here in South Africa, with all this progress, we cannot rest, and we are still on a journey. Almost 2.5 million people living with HIV are not yet on treatment. We have a job to do. There are more than 1400 new HIV infections among adolescent girls and young women every week. This is intolerable.”

Byanyima resolved, “So today, on World AIDS Day, here in South Africa and around the world, let us commit to overcoming the challenges and barriers we still face. Governments have committed to ending AIDS by 2030. We must keep this promise. But business as usual will not get us there.” She said that the main focus should be women and girls. She added that there should be protection of human rights and end of marginalization and end of the “terrible injustice of AIDS-related mortality.” She said, “...we need to put the science and technology to work to save lives. The world has spent billions of dollars developing the fastest tests, the best treatment and new prevention technologies, such as pre-exposure prophylaxis (PrEP) and other women-controlled methods.” She said that without funds this would not have been possible. She said, “We celebrate the commitment of the Government of South African for committing nearly US$ 2 billion per year from domestic public resources for HIV. South Africa is a trailblazer for investing in the fight against AIDS. I urge all governments to follow its lead.”

She concluded, “The world has only one year and one month left to reach the 2020 targets. The world has only 11 years to meet its commitment to end the AIDS epidemic and reach the Sustainable Development Goals. There is no time to lose. We can do it.”

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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Mandal, Ananya. (2019, December 02). New HIV drug combo rolled out in South Africa. News-Medical. Retrieved on June 07, 2020 from https://www.news-medical.net/news/20191202/New-HIV-drug-combo-rolled-out-in-South-Africa.aspx.

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